阿德福韦酯治疗HBeAg阳性慢性乙型肝炎近期疗效分析

目的评价阿德福韦酯治疗HBeAg阳性的慢性乙型肝炎（CHB）患者的疗效。方法58例核苷（酸）类似物初治的HBeAg阳性的慢性乙型肝炎患者，随机分为阿德福韦酯组（10mg／d）36例和安慰剂组22例，分别接受12周治疗后，所有患者均进入为期36周的开放用药（阿德福韦酯10ms／d）阶段。观察患者血清HBVDNA水平、HBeAg和肝脏生物化学功能的变化。结果经过12周的治疗，阿德福韦酯组患者的血清HBVDNA平均下降3．17 log10拷贝／ml，降幅显著高于服用安慰剂组的0．79 log10拷贝／ml（P〈0．05）。第12周和48周时，两组患者的ALT复常率、HBeAg阴转率和HBeAb血清转换率均无明显差异。在治疗结束时，有5例患者出现了HBVDNA反弹，其中1例患者发生了与阿德福韦酯耐药相关的变异。结论（1）阿德福韦酯（10mg／d）治疗HBeAg阳性的慢性乙型肝炎患者具有良好的抗病毒和临床疗效；（2）在48周疗程中，5例（8．8％）患者出现HBVDNA反弹，其中1例为耐药突变，其余4例未检测到相关耐药突变；（3）阿德福韦酯治疗48周，相关耐药突变的发生率为1．7％。

Analysis on the treatment effect of hepatitis B in HBeAg-positive patients with adefovir dipivoxil

Objective To evaluate the effect of adefovir dipivoxil （ADV） on hepatitis B in HBeAg-pasifive patients. Methods Fifty eight patients were divided into two groups randomly. Thirty six patients were treated with ADV （ 10 rag/d） and 22 patients with placebo for 12 weeks. Then all patients were treated with ADV （ 10 mg/d） for 36 weeks and the change of serum HBV DNA level,HBeAg and ALT were observed separately. Results After 12 weeks treatment, the serum HBV DNA of patients with ADV were significantly decreased than that of patients with placebo （P 〈0.05）. Differences of changes of ALT,HBeAg and HBeAb between two groups were not statistically different at 12 and 48 weeks. At the end of treatment, HBV DNA of 5 patients had rebound, 1 of whom was found to have mutations associated with resistance to ADV. Condusions （1） ADV is an effective antiviral treatment for HBV infection with HBeAg positive. （2） During 48 weeks treatment, HBV DNA of 5 patients （8.8%） had rebound, 1 of whom ocurred the mutations associated with resistance to ADV, which was not detected in the other 4 patients. （3）The rate of ADV resistance mutations was 1.7%.